INTRODUCTION • To the best of our knowledge, such a rare combination of double axillary and double brachial arteries encountered in a case of fracture humerus with brachial artery injury is the first to report in clinical practice. • A 30-year-old female presented to our accident and emergency department with fracture right humerus and absent right radial pulse.

CASE STUDY • Her contrast-enhanced computed tomographic angiography revealed high bifurcation of right subclavian artery prior to axilla into two axillary arteries. • The axillary artery-1 continued as the superficial brachioulnar artery. • The axillary artery-2 continued as the deep brachioradial artery with an occlusion in its flow at the level of fracture right humerus. • Distal to the occlusion, the deep brachioradial artery continued to form intact palmar arch with superficial brachioulnar artery.

CONCLUSION The key message of our study is that “every trauma case needs a thorough clinical examination and an adequate radiological examination with proper preoperative planning to avoid iatrogenic injury”. This rare branching pattern is named as “Jain Variation” for literature support.

CT ANGIOGRAPH Axillary artery-2 continued as the deep brachioradial artery with an occlusion in its flow at the level of fracture.